Provider Demographics
NPI:1659644359
Name:BABAUTA, JOEY (LMP)
Entity Type:Individual
Prefix:
First Name:JOEY
Middle Name:
Last Name:BABAUTA
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 OLIVE WAY
Mailing Address - Street 2:SUITE 1645
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101
Mailing Address - Country:US
Mailing Address - Phone:206-226-4466
Mailing Address - Fax:206-682-3802
Practice Address - Street 1:509 OLIVE WAY
Practice Address - Street 2:SUITE 1645
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101
Practice Address - Country:US
Practice Address - Phone:206-226-4466
Practice Address - Fax:206-682-3802
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60270926225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist